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There are ways to mitigate stress by managing its symptoms. However, there are also ways to lessen stress by preventing some of it in the first place.
How quickly things can change. Not so long ago, it almost seemed that the terrible surge of the Delta variant that had dashed our hopes for a “summer of freedom” was finally ebbing. Now, once more, we are seeing cases go up again as we enter the holiday season. It is not just infections; hospitalizations are rising as well, and now the Centers for Disease Control and Prevention CDC has officially stated that the Omicron variant is a “variant of concern.” All this likely means that physicians will not be getting a much-deserved break anytime soon.
Meanwhile, the “Great Resignation” is affecting the health care sector with particular ferocity, with nearly one in five health care workers having left their jobs during the pandemic. Many in this sector had already been experiencing varying degrees of burnout due to numerous other factors, and there was already a shortage of physicians. And the pandemic made an already challenging situation worse. Since one of the primary factors contributing to physician burnout is long-term stress, it becomes all the more vital now for physicians to proactively address these issues.
Before I begin, I do want to provide some context in that most of my work is with private practice physicians. Having said that, I do think there are many parallels between the experiences of physicians in private practice and those in other practice settings, including hospitals and urgent cares.
It’s not just about COVID-19
One thing that may be helpful to remember as a way of contextualizing physician burnout is that much of it is not due to COVID-19 itself, at least not directly. Social distancing guidelines earlier in the pandemic combined with people’s anxieties about going into medical care facilities in person have led to a backlog of work due to patients delaying their needed care. Regardless, the end result for physicians is the same: more work and more stress. Added to this is the aforementioned shortage of staff that may be creating more work for physicians as well.
Why this is so important
Being mindful of burnout and addressing it when it occurs—or, better yet, to prevent it before it occurs—is important for the same reason that the “triple aim” of the medical profession has been updated as “the quadruple aim.” The fourth aim, the health and well-being of physicians and their staffs, is necessary for achieving the other three aims: enhancing the patient experience, and reducing the cost of care. This has always been true but it becomes all the more critical due to the pandemic and its secondary impacts.
There are ways to mitigate stress by managing its symptoms. However, there are also ways to lessen stress by preventing some of it in the first place. Most important is strengthening communication, both internally and externally. By internal communication I mean sitting down with staff and laying it all out, identifying priorities and brainstorming ideas for how to streamline workflow. One of the biggest problems during earlier periods of the pandemic had been mis- or lack of communication. Although more communication may seem like additional work, the amount of work and stress it saves in the long run makes it more than worth the while. Physicians, nurses, and staff can waste less time and energy on fixing mistakes or confusion caused by poor communication and focus instead on providing quality care.
In addition to internal communication, good external communication needs to also be prioritized. For instance, the backlog of patients wishing to come in for overdue checkups or treatment may necessitate longer wait times for appointments. Without sufficient communication, patients may become frustrated or dissatisfied. However, generally speaking, people get more frustrated about a lack of information than they do with the content of the information. Determine what communication approaches are most suitable for your practice and make sure that your staff is adequately trained regarding what needs to be communicated to patients and how.
Identifying and using more resources
Times like now may also warrant looking into and utilizing resources that lighten your burden somewhat. Many doctors spend unnecessary amounts of time and energy on tasks that could be done by other types of professionals—medical case managers, for instance, or members of their staff. Reallocating certain kinds of tasks not only lifts some of the burden from the shoulders of physicians but can also provide the additional benefit of empowering the staff.
In addition to resources that can make life easier for physicians and their staffs, there are also resources that physicians can refer their patients to as well. One of these is telehealth. Many patients may still, even now, not realize that their insurance plans offer telehealth services. Referring patients to these services can help reduce workload while ensuring that patients can still get the care they need for medical concerns that can be adequately addressed through telehealth.
Of course, in addition to referring patients to third party telehealth services offered through their insurance, physicians can offer their own telehealth services as well. Many who utilized telehealth during earlier parts of the pandemic have, for whatever reasons, stopped using it, but telehealth shouldn’t just be a temporary measure. Ideally, it should become a permanent tool that not only increases access to care but can also help streamline the act of providing care. In fact, not only is telehealth an important resource for patients, it can also be a wonderful resource for physicians by helping them to optimize scheduling and support work-life balance. And it is also worth noting that 42 states, along with the District of Columbia, require insurance providers to reimburse for telehealth, and you can use the Center for Connected Health Policy’s policy finder tool for the most current regulations in your state.
Doctors need self-care too
Although it may sound overly obvious, in my experience physicians need to be frequently reminded that they too are human. It is all-too-common for physicians to neglect their mental health. Self-care is not just a good idea, it should be considered a professional imperative. Left unaddressed, chronic stress increases the risk of not just burnout but also depression and anxiety. This is another area where telehealth can help, and there is no reason that physicians can’t also take advantage of the benefits and convenience of using telehealth for mental health services. Physician support groups such as the Physician Moms Group and Physician Dad Support Group on Facebook, or physician-focused support channels such as the peer-to-peer Physician Support Line or the text-based Frontline can help. The Reddit groups r/medicine and r/physicians, while not expressly support groups, also feature many discussion threads where physicians and other healthcare professionals offer various kinds of emotional support to each other. And digital tools such as Headspace, a leading mindfulness and stress management app, can serve as a useful adjunct to behavioral health services targeted towards physicians and healthcare providers. Normally a paid service, Headspace is offering a free two-year subscription for AMA members throughout the pandemic.
Finally, physicians should also try to heed the same recommendations that are often given to their patients, basic principles such as getting enough sleep, staying physically active, and eating as healthy as possible. Again, as obvious as these principles seem, physicians can be quite quick to forget them during busy and stressful times. Many useful reminders such as these can be found on the AMA’s resource page for managing mental health during COVID-19 . While many of these things are certainly easier said than done, the important thing to remember is that they can indeed be done and often make all the difference.
The pandemic really has opened our eyes to different ways of delivering care. With many valuable and effective resources available, it shouldn’t just be about the doctor doing everything. We have learned many useful lessons over the last two years and, hopefully, applying those lessons will help reduce burnout and increase physician resilience.